目的 验证“连生生”生精片对于男性不育症的临床治疗效果及安全性.方法 本研究采用多中心、开放性、剂量固定、前后自身对照的研究方式,对少、弱精子症患者给予生精片治疗12周,分别于第4周、8周、12周时复查精液质量,期间对受试者用药的有效性和安全性进行综合分析.结果 共完成研究189例.受试者在治疗前后精液量和精子形态均无明显变化,但精子密度和活力均有明显提升(P＜0.01),精子形态有明显改善(P＜0.05).患者服用生精片3个月,均未见任何不良事件发生.结论 本研究结果表明,“连生生”生精片是一种可提高少、弱精子症患者精液质量的安全有效药物.

Objective To investigate the effect of chromosome polymorphism on the male spermatogenesis and reproductive outcomes.Methods Totally 3 203 cases of male (infertile group),who were divided into normozoospermia group,aligozoospermia group,azoospermia group according to the sperm count of semen analysis,and 4 893 cases of donor (donor group) were involved the study.Semen analysis,karyotype analysis,and Y chromosome microdeletion test were compared between the groups.The reproductive outcomes of sperm donors and infertile patients were investigated.Results The incidence of polymorphism in infertile group and donor group was 4.62％ and 3.78％ respectively,and the difference was not statistically significant.The incidence of Yqh-in infertile patients increased significantly with the decrease of sperm count (0.15％ in normozoospermia group,0.22％ in aligozoospermia group,0.99％ in azoospermia group),and the difference was statistically significant (P=0.033,compared between normozoospermia group and azoospermia group;P=0.027,compared between aligozoospermia group and azoospermia group),the rate of Y chromosome microdeletion in group C with Yqh-was 56.25％ (9/16),significantly higher than that of other groups (P＜0.05).The incidence of polymorphism in the asthenozoospermia group and teratozoospermia group was 3.92％ and 3.96％,respectively,and the difference was not statistically significant (P＞0.05).Follow-up investigation found that the spontaneous abortion rate was 6.25％ (3/48) and 6.67％ (2/30) in people with polymorphic of donor group and infertile group respectively,no statistical significance (P＞0.05),and no child birth defects were observed.Conclusion Part with azoospermia factor (AZF) microdeletion in Yqh-may lead to spermatogenesis,and other types of polymorphism have no obvious effect on male fertility.

Objective To explore the Impacts of Huangjingzanyu capsule on sperm DNA integrity of patients with asthenospermia. Methods Flow Cytometry(FCM) and computer-assisted semen analysis(CASA) were used to detect and analyze the changes of semen parameters and sperm DNA integrity index(DFI) before and after the therapy, in which 58 patients with asthenospermia took Huangjingzanyu capsule for three months. Results The sperm density, sperm motility a, a+b and sperm viability of the 58 patients negatively correlated with DFI(r=-0.38,-0.56,-0.52,-0.64, P<0.05) before the therapy while the teratospermia rate positively correlated with DFI (r=0.42, P<0.05). After three months, there were signifi-cant differences in above parameters (P<0.01) and no significant differences were found in volume(P=0.301), pH(P=0.098) or liquate time(P=0.796) of semen before and after the therapy. In addition, the change of DFI had no difference(P=0.326) in the group with normal DFI before the therapy, whereas the change had significant difference(P=0.000) in the group with ab-normal DFI before the therapy. Conclusion For the patients with asthenospermia, Huangjingzanyu capsule can significantly improve the density, number, motility and viability of their sperm and reduce the teratospermia rate, and it can also improve the sperm DNA integrity for those who have abnormal DFI.

Objective To explore the therapeutic effects of scrotal cooling patch combined with Vitamin E on infertile males with varicocele.Methods From July 2015 to June 2016, there were 76 infertile males with varicocele enrolled in the research,they were divided randomly into two groups and recept treatments in three hospitals. 40 patients in Group one took Vitamin E, at the same time using scrotal cooling patch nocturnally. 36 patients in Group two only took Vitamin E. Scrotal temperature and semen analysis were performed before and 4,8,12 weeks after treatment. 39 normozoospermiaic males without varicocele were enrolled as control group.Results Compared with control group, 76 infertile males with varicocele showed higher scrotal temperature(35.2℃vs control group 33.5℃,P<0.05 ) and deteriorated semen quality. Patients in group one showed the same level of scrotal temperature and semen parameters compared with that of group two before treatment. Patients in group one showed decreased scrotal temperature and increased semen parameters monthly. After 12-week treatment, the average scrotal temperature of patients in group one was statistically lower than that in group two (34.2℃vs35.0℃), the average sperm density and progressive motile sperm percentage in group one were higher than that in group two(26.8×106/mL vs22.5×106/mL, 34.5% vs 28.8%,P<0.05).Conclusion Consecutively scrotal and testicular cooling is able to improve semen quality in infertile males with varicocele.

Objective To screen proteins that interact with MLH1, the key protein in meiosis recombination in spermatogenesis.Methods Mouse testis cDNA library was screened by the bait of MLH1 using yeast two hybrid system to find proteins interact with MLH1, and the interaction was validated by GST pull-down and co-immunoprecipitation.Results Total of 29 interaction proteins were found on the plate of SD/-Ade/-His/-Leu/-Trp by yeast two hybrid screening, including the known interaction proteins of MLH3 and PSM2. A new interaction protein was found which was named as RHNO1, and the interaction was confirmed by GST pull-down and co-immunoprecipitation. The high expression level of RHNO1 in testis revealed by real-time PCR indicates that RHNO1 may have important function in spermatogenesis. Conclusion Yeast two hybrid system is an effective method to find new interaction proteins, and we have identified a new protein (called) RHNO1 interacted with MLH1, which may play roles in meiotic homologous recombination.

在男性不育的治疗中，显微外科技术的介入，使患者通过有效的外科治疗，改善或者恢复生育力。目前男性不育的显微外科治疗包括精索静脉曲张显微结扎术、输精管输精管显微吻合术、输精管附睾管显微吻合术及睾丸显微取精术。精索静脉曲张显微结扎术适用于合并精索静脉曲张的少弱精子症患者，输精管输精管显微吻合术应用于输精管结扎术要求复通者及输精管离断者，输精管附睾管显微吻合术适用于感染或者原发性附睾梗阻患者，这两种手术通过恢复输精管道通畅使患者获得自然授孕的机会。睾丸显微取精术用于非梗阻性无精子症（ non-obstructive azoospermia ， NOA）患者，所取精子结合辅助生殖技术可使患者生育自己的子代。男性不育的显微外科治疗技术的推广，提高了男性不育的整体疗效与治疗水平，成为除辅助生殖治疗以外的重要的治疗组成部分。

目的:回顾分析500例无精子症的临床诊治,为提高男性不育症规范化诊治水平提供参考.方法:回顾性分析2012年12月-2013年12月间收治的无精子症患者500例,根据中华医学会2013版《男科疾病诊治指南系列男性不育症诊疗指南》诊断为梗阻性、非梗阻性、混合性无精子症;分别提供附睾、输精管、射精管等精道重建手术、药物治疗、体外受精(IVF)/胞浆内单精子注射(ICSI)、供精人工授精(AID)及收养等方案供患者夫妇知情选择.结果:500例中梗阻性无精子症254例、非梗阻性无精子症187例、混合性无精子症40例,Y染色体AZFa或AZFb微缺失所致的无精子症19例.手术治疗的44例患者中,14例接受精囊镜射精管囊肿切开术、5例接受输精管-输精管吻合术、25例接受输精管-附睾吻合术;其中33例在术后3～12个月内行精液检查发现精子,2例在术后3～8个月女方自然妊娠;药物治疗的19例患者中,7例炎症性梗阻患者给予抗生素治疗1～3个月后,3例在3～6个月精液检查时发现精子,其中1例在治疗后5个月内女方自然妊娠,其余4例患者的生殖系统不适症状较前明显缓解;12例低促性腺激素患者给予卵泡刺激素(FSH)和(或)人绒毛膜促性腺激素(hCG)治疗,其中包括1例Kallmann综合征,9例患者经3～12个月随访,睾丸体积明显增大(＞4～8 mL),血清睾酮明显增高,其中5例在6～12个月内精液中出现精子;IVF/ICSI治疗组的376例患者12个月内成功妊娠者196例;其余61例选择AID或收养.结论:依据中华医学会《男科疾病诊治指南系列男性不育症诊疗指南》谨慎有创操作,倡导医患共同决策诊疗行为,对于临床上无精子症规范化与合理的诊治具有积极意义.

目的 初步研究β-catenin蛋白在不同类型睾丸肿瘤中的表达特性,并探讨β-catenin分子的表达与睾丸肿瘤的关系,为临床诊断或治疗睾丸肿瘤提供一定依据.方法 随机收集我院于2012年1月至2012年12月期间确诊的21例睾丸肿瘤组织和1例梗阻性无精子症(OA)患者的睾丸活检组织(作为正常对照,其睾丸生精功能正常);同时,选取5只9周龄的ICR小鼠作为实验补充.采用了免疫组化、Western blots和RT-qPCR等方法来检测β-catenin的表达情况.结果 在梗阻性患者中,β-catenin在精原细胞的胞膜和胞浆中呈现低表达;在小鼠中,β-catenin也仅表达在精原细胞的胞浆和胞膜上.在睾丸肿瘤组织中,睾丸孤立性纤维肿瘤中可检测到β-catenin的mRNA和蛋白的高表达,分别为OA患者的9.4倍和17倍,且其β-catenin主要异位表达在细胞核中,可检测到磷酸化的β-catenin的表达.然而,β-catenin在睾丸精原细胞肿瘤和间质细胞肿瘤中不表达或低表达.结论 本研究初步表明β-catenin与正常的睾丸生精过程及病理的睾丸孤立性纤维肿瘤发生发展相关,而与睾丸精原细胞肿瘤和间质细胞肿瘤之间无明显相关性.但仍需扩大样本数量进行研究,或采用动物实验深入研究.

随着辅助生殖技术的广泛开展，生殖男科备受关注。针对各种无精子症患者，临床可以通过外科手段获取精子，用于后续的辅助生殖技术，帮助不孕不育的夫妇获得生物性后代。不同的取精术，各有优劣，手术操作也各有技巧。本文介绍了目前生殖中心常用的外科取精技术，并总结了各自的适应证和注意事项，旨在进一步完善外科取精的流程，更好的服务患者和优化医疗资源。

男性不育发病率正逐年升高，但大多数病因并非十分清楚。因此，男性不育通常缺乏特效的治疗方案。雄激素补充是治疗男性不育的一种方式，但其作用效果存在较大的争议，甚至出现两种截然相反的观点。本文将外源性睾酮补充治疗男性不育的有利与不利观点分别列出各自的支持与不支持论据，并将两者进行对比分析。通过综合分析发现，大剂量外源性睾酮补充治疗应摒弃，提高内源性睾酮的治疗方案可能更适合于少弱精症患者，小剂量、短期外源性睾酮补充治疗是否有利于男性不育则需要进一步的临床证据。

人类精子库的建立对于解决人类不育难题、提供生殖保险具有重要意义,但这些进步背后也存在一系列复杂的家庭、社会和法律等伦理问题.就精子库工作中常见的伦理问题,如精子的使用方式、社会问题及其他问题作了分析.并提出对策:建立定期伦理督查制度,加强人类精子库管理;加强医学、伦理及法制知识的宣传普及工作,提高医务人员的道德责任感.

Objective To evaluate the sexual and reproductive function of 54 cases with testicular neoplasm after operation. Methods From January 2003 to November 2011,clinical data of 54 cases with testicular tumor were retrospectively reviewed in the department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University. Results Of 54 patients with testicular tumor who received pathological examination 34 cases were diagnosed as seminoma(62.9%), embryonal carcinoma, metastatic lymphoma ,mixed germ cell tumor and spermatic cord tumors were 4, 4, 2, 2 respectively. Also, there were 8 cases of other types of tumor. Based on the pathology diagnosis and clinical stage, 21 cases underwent lymphatic radiotherapy and 15 cases chemotherapy, 6 cases combined treatment of radiotherapy and chemotherapy. All 54 cases were reviewed effectively. 35 cases had a satisfied sexual function after the operation and adjuvant therapy, but 19 cases complained of their sex ability. For 23 fertile-age(20-40) patients, 8 cases were not marriage,and the other 8 cases had a normal eugenesis . Conclusion Patients with testicular tumor had a good prognosis after surgical resection, but irradiation, chemotherapy or adjuvant combined chemotherapy were harmful to their sexual and reproductive function.

本文首先利用带有记忆功能的禁忌搜索算法的全局寻优能力训练神经网络,然后将训练好的神经网络用于短期负荷预测.该方法具有较强的自适应能力和较好的预测效果,是可行有效和实用的.

Objective To study the effects and safety of sildenafil combined with testosterone undecanoate for treatment of Erectile Dysfunction (ED)with Diabetes. Methods A total of 100 ED patients with diabetes from Panyu Central Hospital of Guangzhou, Renji Hospital, Shanghai Jiao Tong University School of Medicine, and Traditional Chinese Medicine Hospital of Shanghai, were recruited in the study. Informed consent was obtained from each patient. They were evaluated by the International Index of Erectile Function Table(IIEF-5) and randomly assigned to two groups. Patients in Group A received sildenafil combined with testosterone undecanoate (80mg/Bid) (n=50), while patients in Group B received sildenafil only (n = 50) for 12 weeks. Both treatments were on the basis of glycemic well control. We assessed the differences of efficacy between two treatments, and recorded the adverse events for safety evaluation. Results Total of 82 patients completed the study, including 42 in Group A and 40 in Group B. Both Groups had significant increases in IIEF scale (P<0.05). The increase of IIEF scale in Group A was more dramatic than that in Group B (P<0.05). The obvious effective rate and effective rate of Group A were 59.52% and 88.10% respectively, higher than that of Group B (30.00% and 55.00%), with P value lower than 0.05. No adverse events were noted in two groups. Conclusion Compared to sildenafil therapy only, Sildenafil therapy combined with testosterone undecanoate can improve the sexual function of ED patient with diabetes, having a more satisfactory drug safety.

Objective To evaluate the outcomes of microdissection testicular sperm extraction (MD-TESE) and conventional testicular sperm extraction (TESE) in patients with non-obstructive azoospermia (NOA).And to investigate the factors that influence the sperm retrieval rate (SRR) of the MD-TESE.Methods One hundred and seven non-obstructive azoospermia patients accepting conventional TESE and MD-TESE in our institute.Testicular tissues were minced and observed under microscope with 400 magnification.The relationships between SRR and testis volume,serum FSH and pathological category were analyzed.Results There were 46 patients retrieved testicular sperm successfully in conventional TESE,versus 61 patients in TESE combined with MD-TESE.Compared with conventional TESE about pathological types,sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of Sertoli cell only syndrome (SCOS,45.1％:32.4％,P ＜ 0.01) than in the groups of maturation arrest (MA,59.1％:40.9％,P=0.25) andhypospermatogenesis (HS,92.9％:78.6％,P=0.5).At the meantime,sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of HS (92.9％) than in the groups of SCOS (45.1％) and MA (59.1％).Compared with conventional TESE about testicular volume,sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of ＜10mland ＞6 ml (54.2％:31.3％,P＜0.01 =than in the groups of ＞15 ml (55.6％:50.0％,P =1.0) and 10-15 ml (61.0％:53.7％,P =0.25).However,sperm retrieval rates of TESE combined with MD-TESE were similar in the groups of ＞ 15 ml,10-15 ml,＜ 10 ml and ＞6 ml (55.6％,61.0％,54.2％,respectively,P =0.77).Compared with conventional TESE about serum FSH concentration,sperm retrieval rate of TESE combined with MD-TESE was significantly higher in the group of ＞ 12.6IU/L (56.9％:41.7％,P＜0.01 =than in the group of ≤12.6 U/L (45.7％:57.1％,P=0.125).But,sperm retrieval rates of TESE combined with MD-TESE were similar in the groups of ＞ 12.6 U/L,≤12.6 U/L (56.9％,57.1％,respectively,P =0.98).Conclusions Sperm retrieval rate of TESE combined with MD-TESE was significantly higher than conventional TESE.And sperm retrieval rate was associated with pathological types.Testicular volume and serum FSH concentration were not indexes of the success of TESE combined with MD-TESE.

Objective To discuss the application of microsurgery in the treatment of male infertility.Methods From March 2007 to March 2012,there were totally 853 infertile men received microsurgical treatments in our department.Among them,344 patients with unilateral or bilateral varicocele underwent microsurgical varicocelectomy,60 underwent vasovasostomy (VV) and 192 underwent vastoepidystomy (VE)in microsurgical methods due to obstructive azoospermia.257 non-obstructive azoospermia (NOA) patients were performed microdissection of testicular sperm extraction (MD-TESE),at the same time,pathologic examination was done.Results ①For the varicocele patients,the pre-operative sperm density was (10 ±6) × 106/ml,the progressive sperm percentage was (16 ± 9)％.The post-operative density was (15 ± 8) ×106/ml,the progressive sperm percentage was (28 ± 14)％.The natural pregnant rate was 10.8％ (37/344).②In 60 patients undergone VV,the patent rate was 80.0％ (48/60),the natural pregnant rate was 35.0％ (21/60).In 192 VE patients,the patent rate was 53.1％ (102/192),the natural pregnant rate was 19.8％ (38/192).③In 257 NOA patients,the testicular volume,sperm retrieval rate of MD-TESE was significantly higher than that of conventional testicular sperm extraction (60.3％ vs.38.1％).Conclusion The microsurgery techniques in male infertility treatments could have some advantages such as explicit effects and decreased injuries.

Klinefelter syndrome (KS) is the most common male chromosome aneuploidy. Its pathophysiology is largely unexplained due to the lack of adequate models. Here, we report the derivation of induced pluripotent stem cell (iPSCs) lines from a KS patient with a karyotype of 47, XXY. Derived KS-iPSCs meet all criteria of normal iPSCs with the potential for germ cell differentiation. Although X chromosome inactivation occurs in all KS-iPSCs, genome-wide transcriptome analysis identifies aberrantly expressed genes associated with the clinical features of KS. Our KS-iPSCs can serve as a cellular model for KS research. Identified genes may become biomarkers for early diagnosis or potential therapeutic targets for KS and significantly accelerate the understanding, diagnosis, and treatment of Klinefelter syndrome.